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Free Content Higher cost of implementing Xpert® MTB/RIF in Ugandan peripheral settings: implications for cost-effectiveness

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SETTING: Initial cost-effectiveness evaluations of Xpert® MTB/RIF for tuberculosis (TB) diagnosis have not fully accounted for the realities of implementation in peripheral settings.

OBJECTIVE: To evaluate costs and diagnostic outcomes of Xpert testing implemented at various health care levels in Uganda.

DESIGN: We collected empirical cost data from five health centers utilizing Xpert for TB diagnosis, using an ingredients approach. We reviewed laboratory and patient records to assess outcomes at these sites and10 sites without Xpert. We also estimated incremental cost-effectiveness of Xpert testing; our primary outcome was the incremental cost of Xpert testing per newly detected TB case.

RESULTS: The mean unit cost of an Xpert test was US$21 based on a mean monthly volume of 54 tests per site, although unit cost varied widely (US$16–58) and was primarily determined by testing volume. Total diagnostic costs were 2.4-fold higher in Xpert clinics than in non-Xpert clinics; however, Xpert only increased diagnoses by 12%. The diagnostic costs of Xpert averaged US$119 per newly detected TB case, but were as high as US$885 at the center with the lowest volume of tests.

CONCLUSION: Xpert testing can detect TB cases at reasonable cost, but may double diagnostic budgets for relatively small gains, with cost-effectiveness deteriorating with lower testing volumes.
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Keywords: cost-benefit analysis; diagnostic tests, routine; molecular diagnostic techniques; tuberculosis

Document Type: Research Article

Affiliations: 1: Johns Hopkins University School of Medicine, Baltimore, Maryland, USA 2: Population Services International, Washington DC, USA 3: Department of Medicine, Clinical Epidemiology Unit, Makerere University College of Health Sciences, Kampala, Uganda 4: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA 5: Division of Pulmonary and Critical Care Medicine and Curry International Tuberculosis Center, University of California San Francisco, San Francisco, California, USA 6: Department of Epidemiology (Microbial Diseases), Yale School of Public Health, New Haven, USA; Pulmonary, Critical Care, and Sleep Medicine Section, Yale School of Medicine, New Haven, Connecticut, USA 7: London School of Hygiene & Tropical Medicine, London, UK

Publication date: September 1, 2016

More about this publication?
  • The International Journal of Tuberculosis and Lung Disease publishes articles on all aspects of lung health, including public health-related issues such as training programmes, cost-benefit analysis, legislation, epidemiology, intervention studies and health systems research. The IJTLD is dedicated to the continuing education of physicians and health personnel and the dissemination of information on lung health world-wide.

    To share scientific research of immediate concern as rapidly as possible, The Union is fast-tracking the publication of certain articles from the IJTLD and publishing them on The Union website, prior to their publication in the Journal. Read fast-track articles.

    Certain IJTLD articles are also selected for translation into French, Spanish, Chinese or Russian. These are available on the Union website.

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